Prevention and Treatment of Heat Illness

Publication Date: July 1, 2019
Last Updated: March 14, 2022

Recommendations

Prevention and planning

Screen for significant pre-existing medical conditions. (1 – Strong, B)
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Minimize use of medications that could limit the thermoregulatory response. (1 – Strong, C)
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Recognize that an overweight body habitus is associated with greater risk of heat illness. (1 – Strong, B)
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Promote regular aerobic activity before heat exposure. (1 – Strong, C)
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Allow for acclimatization with 1 to 2 h·d-1 of heat-exposed exertion for at least 8 d. (1 – Strong, C)
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Ensure euhydration before activity. (1 – Strong, B)
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Ensure ongoing rehydration with a “drink to thirst” approach sufficient to prevent >2% loss of body weight. (1 – Strong, B)
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Consider history of heat injury as a reversible risk factor for recurrence. (1 – Strong, C)
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ENVIRONMENTAL CONSIDERATIONS

The wet-bulb globe temperature index (WBGT) should be used for the assessment of heat risk. (1 – Strong, A)
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ACTIVITY CONSIDERATIONS

Consider which mechanisms of heat accumulation or dissipation are dominant during an activity, and consider heat loss as a key feature of breaks. (1 – Strong, C)
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CLOTHING AND EQUIPMENT

Clothing and equipment for a given activity should be evaluated and modified as needed to optimize evaporative, convective, conductive, and radiative heat exchange or isolation. (1 – Strong, C)
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Field treatment

Removal from the heat and rapid cooling is critical because the extent of morbidity is directly related to both to the degree and duration of hyperthermia. (, U)
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MINOR HEAT ILLNESS TREATMENT

Heat syncope patients whose event is recurrent and inconsistent with exercise-associated collapse or other clear explanation should be referred for further cardiology diagnostics. (2 – Weak, C)
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TEMPERATURE MEASUREMENT

When available, rectal temperature should be considered the most accurate measurement of core hyperthermia compared to axillary, oral, or aural thermometry. (1 – Strong, B)
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In a hyperthermic individual with an altered sensorium, the initiation of empiric cooling for heat stroke should not be delayed by a measurement value that may be below the diagnostic threshold of 40°C. (1 – Strong, B)
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PASSIVE COOLING

Passive cooling measures should be used to minimize thermal strain and maximize heat loss. (1 – Strong, C)
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HYDRATION

Dehydration should be minimized in heat illness. (1 – Strong, C)
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Intravenous fluids should be used for rehydration in EHS. (1 – Strong, B)
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COLD WATER IMMERSION THERAPY

Cold water immersion is the optimal cooling method for heat stroke. (1 – Strong, A)
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EVAPORATIVE COOLING

Evaporative or convective cooling can be considered as adjunct cooling methods if cold water immersion is unavailable. (1 – Strong, C)
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CHEMICAL COLD PACKS/ICE PACKS

Ice packs should be applied to cover the entire body. (1 – Strong, C)
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If chemical cold packs are used, they should be applied to the cheeks, palms, and soles rather than the skin covering the major vessels. (, )
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ANTIPYRETICS

Antipyretics should be avoided in heat illness. (2 – Weak, B)
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Hospital treatment

CONDUCTIVE COOLING

Cold water immersion should be considered for EHS in the hospital setting. (1 – Strong, A)
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Cold water immersion can be considered for treatment of classic heat stroke patients. (1 – Strong, C)
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EVAPORATIVE AND CONVECTIVE COOLING

Evaporative and convective cooling may be considered in classic heat stroke in the hospital setting, but cooling rates with this method are inferior to those with conductive cooling. Evaporative and convective cooling is not indicated in EHS, unless effective conductive cooling is not available. (1 – Strong, C)
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TARGET COOLING TEMPERATURES

Heat stroke patients should be cooled to a target temperature of no less than 39°C. (1 – Strong, B)
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ADJUNCTIVE COOLING TREATMENTS

Cold intravenous fluids should be given for adjunctive cooling in heat stroke. (1 – Strong, C)
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Intravascular cooling catheters or cold water lavage are not recommended primary treatments for heat stroke. (2 – Weak, C)
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PHARMACOLOGIC TREATMENT

Dantrolene should be avoided for treatment of heat stroke patients. (2 – Weak, B)
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Recommendation Grading

Overview

Title

Prevention and Treatment of Heat Illness

Authoring Organization

Publication Month/Year

July 1, 2019

Last Updated Month/Year

April 13, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Childcare center, Emergency care, Hospital, Medical transportation

Intended Users

Paramedic emt, athletics coaching, nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D018883 - Heat Stroke, D006359 - Heat Exhaustion

Keywords

prevention, Heat Illness, hyperthermia, heat stroke, recognition, Heat cramps, Heat syncope